The Surgical Resident Communication Experience: A Prospective Observational Needs Assessment.

IF 2.1
Anna Newcomb, McKenna Stidham, Holly Wehrlen, Mckenzie Rowe, Rachael Cal, Jonathan Dort
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Abstract

Background: Skillful communication is a vital part of a surgeon's toolkit. Surgical resident day-to-day communication tasks include conducting informed consent discussions, guiding families through end-of-life conversations, coordinating care with colleagues, and demonstrating competence to educators. It is not known which are most challenging and therefore should be prioritized in training. To date, no studies have prospectively captured the communication activities of surgical residents and their sense of comfort and competence performing these varied tasks.

Methods: We performed a prospective observational study of surgical residents and their communication during meetings with patients, families, and colleagues in the clinical setting. Researchers recorded location and length of encounters, goal and topic of conversations, resident reflections, and researcher observations. Resident comments and researcher field notes were analyzed for the range of experiences and common themes.

Results: A total of 300 encounters were recorded from 23 residents, with 60% (n=175) involving interns. Half occurred on the medical-surgical wards and lasted under five minutes. Interns rated encounters lowest when facing unfamiliar clinical protocols, non-standardized care, interpreter technology challenges, and frequent electronic interruptions. More experienced residents cited frustration with other professionals or services and unclear processes for recurring situations. Senior residents expressed less distress than juniors when navigating unfamiliar clinical situations. Interns often internalized conflicts, attributing challenges to their lack of experience and knowledge, while senior residents tended to externalize similar frustrations, citing others' missteps. Across all levels, high-stakes discussions with patients and families were seen as challenging, but not as distressing as hospital systems, technological issues, and colleague disagreements.

Conclusion: Our findings inform recommendations for topics to include in training, such as negotiating conflicting clinical plans, managing poorly defined consults, and supporting families despite strict time constraints. Longitudinal and multi-institutional data collection would provide more insight into communication training needs.

外科住院医师沟通经验:前瞻性观察需求评估。
背景:熟练的沟通是外科医生工具箱的重要组成部分。外科住院医师的日常沟通任务包括进行知情同意讨论,指导家属进行临终对话,与同事协调护理,以及向教育工作者展示能力。目前还不知道哪些是最具挑战性的,因此应该在培训中优先考虑。到目前为止,还没有研究前瞻性地捕捉到外科住院医生的沟通活动以及他们执行这些不同任务的舒适度和能力。方法:我们对外科住院医师进行了一项前瞻性观察研究,以及他们在临床环境中与患者、家属和同事会面时的沟通情况。研究人员记录了会面的地点和时长、谈话的目标和话题、居民的感想以及研究人员的观察结果。对居民评论和研究人员实地记录的经验范围和共同主题进行了分析。结果:共记录了23名住院医师的300次接触,其中60% (n=175)涉及实习生。其中一半发生在内科-外科病房,持续时间不到5分钟。在面对不熟悉的临床方案、非标准化护理、翻译技术挑战和频繁的电子干扰时,实习生对遭遇的评价最低。更有经验的居民表示,他们对其他专业人士或服务感到沮丧,对反复出现的情况流程不明确。在面对不熟悉的临床情况时,老年住院医生比年轻住院医生表现出更少的痛苦。实习生常常把矛盾内在化,把挑战归咎于他们缺乏经验和知识,而老年住院医生则倾向于把类似的挫折外在化,归咎于别人的失误。在各个层面,与患者和家属进行高风险的讨论被视为具有挑战性,但不像医院系统、技术问题和同事分歧那样令人痛苦。结论:我们的研究结果为培训的主题提供了建议,如协商冲突的临床计划,管理定义不明确的咨询,以及在严格的时间限制下支持家庭。纵向和多机构数据收集将更深入地了解通信培训的需要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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